1275713513 NPI number — EMILIE E EGBE

Table of content: EMILIE E EGBE (NPI 1275713513)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275713513 NPI number — EMILIE E EGBE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EGBE
Provider First Name:
EMILIE
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275713513
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/04/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
29 E 29TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BAYONNE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07002-4654
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-858-5263
Provider Business Mailing Address Fax Number:
201-858-7334

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
34 HILLSDALE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAST BRUNSWICK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08816-4318
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-432-7221
Provider Business Practice Location Address Fax Number:
732-432-7217
Provider Enumeration Date:
11/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  28R102109700 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 28R102109700 . This is a "PHARMACY LICENSE/NJ" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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